颈椎病伴颈源性眩晕的临床分析

目的探讨伴颈源性眩晕的颈椎病发病机制和颈前路手术疗效。方法对2008年3月-2012年11月收治的293例颈椎病患者中83例伴有颈源性眩晕者进行手术治疗,其中神经根型颈椎病23例,脊髓型颈椎病60例。病变涉及单节段29例,2个节段50例,3个节段4例。对全部病变节段均行前路减压固定融合术。观察比较术前、术后3 d、及末次随访时眩晕缓解情况,采用颈性眩晕症状与功能评估量表30分法评定眩晕及主观满意情况,日本骨科学会评估治疗分数法评定神经脊髓功能改善情况。结果随访12～30个月,平均21个月。两种评分在术后3 d、末次随访与术前比较差异有统计学意义（P〈0.05）,末次随访与术后3 d比较差异无统计学意义（P〉0.05）。结论颈源性眩晕手术效果往往伴随脊髓和神经根症状改善而缓解,颈椎病伴颈源性眩晕采取手术治疗是一种有效的方法。

Clinical Analysis of Cervical Spondylosis Combined with Cervicogenic Vertigo

Objective To explore the pathogenesis of cervical spondylosis combined with cervicogenic vertigo, and to investigate the clinical results of anterior discectomy and fusion in treating the disease. Methods A retrospective study was performed on 83 patients with cervical spondylosis myelopathy（n=60, 72%） or radiculopathy（n=23, 37.3%） accompanied by sympathetic symptoms such as dizziness between March 2008 and November 2012. The disease involved single segment in 29 cases, double segment in 50 cases, and triple in 4 cases. All the segments involved were treated with anterior discectomy and fusion. Vertigo alleviation was observed before surgery, 3 days after surgery, and during the final follow-up. Neurological status was evaluated by Japanese Orthopedic Association（JOA） score system and sympathetic symptoms were evaluated with vertigo symptom and function scoring system. Results The average follow-up was 21 months（ranging from 12 to 30 months）. Significant difference was observed between sympathetic symptom scores and JOA scores before surgery and 3 days after surgery or at the final follow-up（P〈0.05）, but no significant difference was found between the scores 3 days after surgery and during the final follow-up（P〉0.05）. Conclusions The surgical effect for cervicogenic vertigo is often accompanied by the relief of spinal cord and nerve roots symptoms. Surgery is effective for cervical spondylosis combined with cervicogenic vertigo.